Friday, June 24, 2011

Several of my patients are nurses at the hospital I work at. So yesterday afternoon, while I was on rounds, one came over and asked if she could talk to me in private.

So a few minutes later I met her in an empty room. She told me that she found out last week that she's pregnant, and so she stopped her migraine medication. I told her that's fine, and congratulated her.

15 minutes later, while walking out to my car, I noticed her standing outside.

Stupid, yes, but that's how addiction goes - it doesn't succumb to logic. If it did, there would be a good deal fewer addicts of any kind.

Don't judge this nurse too harshly right now. She's just had major, life-changing news and expecting her to give up something that she depends on for emotional stability on the same day is unreasonable.

She should, however, be encouraged to give up, but with support and encouragement, not scorn and judgement.

I used to run every day and occasionally do marathons. I would often run with a man in our training group who was more or less a chain smoker. He normally didn't smoke when he ran (hard to do I imagine), but sometimes on long runs, he even lit up in the middle of a run.

I was talking to him one day and he said he ran for his health. I told him giving up smoking would do more for his health than if he ran a marathon every day.

Well, to give her the benefit of the doubt, a lot of OBs tell smokers to cut down gradually instead of quitting cold turkey when pregnant, so if she just found out maybe that's what she's trying to do.

There are young women who really believe that by smoking they will have a smaller baby (they know smoking is associated with low birth weight) and so labour will be easier and they will stretch less. I know, I know...

Kind of like the woman pregnant with her 1st child who exercised, worked only 3 days a week due to "stress of pregnancy" and then who said she liked wine too much to give it up... then wondered why her son was chronically colicky.

She's now a partner in a big, big firm and I'm poor. She couldn't care less about her unborn child but makes it to the top of big business.

Reminds me of a few years ago. I was waiting at the pharmacy, they were having some trouble with a script for a woman in the drive-through. Throughout the whole thing she was chain-smoking. I recognized her script as being for asthma.

I'm a nurse. I've been stressed. (nothing more stressful than having children!) I don't smoke. There are plenty of stupid nurses and RT's who smoke and are fat. I take care of myself because I don't want to set a bad example for my patients.

I know her! She's just like the gal I work with who says, "Oh, an occasional glass of alcohol won't hurt anything." Hmm, guess the baby's brain cells don't matter...

And, just like the AMA nurse (advance maternal age) who didn't believe her doc when she told her to watch the salt and sugar in her diet (stay away from chips and Twinkies), she got insanely high BP, and delivered 5 weeks early.

@amy: My mother is a fat nurse. According to what you wrote, she is stupid because she is fat? Am I to understand you right? Because if that is what you are saying, you are the one who is stupid (and obnoxious).

I need to echo Ann Onny (thank you!). My 87 year old mother likes to tell those judgmental of pregnant women that she smoked and drank through the entirety of her three pregnancies. The only thing that concerned her doctor was that she not gain weight. As the first fetus, I can attest that there were no ill effects of her bad habits (going on 60 years later). You guys need to stop believing the crap you tell your patients. It's all genes. If you got good ones, you'll probably survive most of what you do. If you don't have good ones, you're dead meat no matter how careful you are.

Hildy....many of us children of the fifties also rode bikes without helmets, stood between the bucket seats in our parents' Impala while they chain smoked, played outide alone for 12 hours in the summer, mowed the lawn in bare feet & drank the leftover booze in glasses from last night's party while the adults slept in. Yup, we lived and are fine, but replicating any of this would land a parent in hot water in the 21st century.

Oh--and as other have noted, our mothers drank, smoked, were placed on 1200 Cal. diets and in some cases given amphetamines so they would not gain "too much" weight. Fifteen pounds for the entire pregnancy was pushing the upper limits of weight gain...all so that we would be nice, tiny babies to deliver.

Your insistence on relying on ones genes sounds like the rationale given by my morbidly obese, diabetic, alcohol abusing, chain smoking brother-in-law, who claims good DNA is on his side.

BTW---he is a Cardiac Intensive Care RN. We won't be flying to Florida for the inevitable funeral.

My aunt has six kids, and she used to smoke. She smoked for the first 4 pregnancies, and had one stillborn, three with low birthweight, two of which have had continuing poor health (asthma, repeated ear infections, etc). She quit smoking after her fourth pregnancy (when the first child was diagnosed as asthmatic), and went on to have another three children - all of whom had normal birthweights, and were healthier than the older three. A lot of this could be down to chance, or other environmental factors, but her experiences make me strongly against smoking.

Why point to an extreme to make your case? Like your "morbidly obese, diabetic, alcohol abusing, chain smoking brother-in-law???" How about being maybe 10 lbs overweight but spending lots of time working in the garden, playing sports, biking or walking rather than driving? Or having an occasional cocktail or glass of wine? Or an occasional cigar or cigarette? In other words, doing things in moderation? There's nothing sadder than someone who has killed himself to exercise, has 1% body fat from a diet of twigs and leaves, never so much as been in a room with a cigarette, who then gets told he has lung cancer. Because we lead people to believe that we can completely control our destinies if we just do the "right things." We can't. You live long enough, the universe will crap on you. And, yes, childhood used to be a great deal of fun before parents became so overly protective and anal.

I was baffled last year when asked to give a presentation to a bunch of young Buddhists. I usually think of Buddhists as people who are very mindful, eat well, walk gently on the earth, etc., etc., so I was not prepared to find that the vast majority went out for a cigarette on their break. Wild. But, yeah, addiction, and we do all die of SOMETHING, and some of the things we think are healthy nowadays will be proven otherwise in the next hundred years.

It's funny to hear the rants against alcohol and pregnancy. Half a glass of wine once in a while with dinner? Sipped slowly? I doubt it causes problems. European doctors won't scold you for very light consumption.

Reminds me of exiting a hospital by the side door after visiting my mother who had end stage COPD. She was a long time smoker. Several nurses, including one caring for my mother, were on a smoke break. Tobacco is an addiction. Trust me on that.

Had a pregnant patient yesterday who we were thinking of doing a chest x-ray on - she completely flipped out because of 'all the radiation' and then she asked me if she could go outside for a bit because we got her all upset thus she needed a cigarette... So sad and frustrating!!! But policing people's behavior to 'protect them or their unborn children' is a very tricky business...

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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